Written by Millie Cossé
Approximately half of patients with high-risk occlusion myocardial infarction (OMI) do not meet STEMI criteria, making it extremely important that EM physicians recognize high-risk OMI patterns on EKG.
There’s so much more than STEMI/NSTEMI
This narrative review article describes high-risk EKG patterns suggestive of OMI (see image below). There is a growing body of evidence to suggest that the traditional STEMI/NSTEMI paradigm fails to accurately identify a large number of cases of acute coronary occlusion. Failure to recognize other high-risk OMI EKG patterns leads to delays of care and worse outcomes.
It is also important to note that the American College of Cardiology recognizes several of these patterns (posterior STEMI, left bundle branch with Modified Sgarbossa-Smith criteria, De Winter sign, and hyperacute T-waves) as “STEMI equivalents” in their 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department.
How will this change my practice?
Cath lab activation practices will vary by institution, but any patient with concerning symptoms and one of the EKG patterns described in this paper warrants a phone call with cardiology to discuss emergent catheterization.
Another Spoonful
Take a look at the original OMI manifesto by Drs. Smith, Weingart, and Meyers.
Source
ECG Patterns of Occlusion Myocardial Infarction: A Narrative Review. Ann Emerg Med. 2025 Jan 17:S0196-0644(24)01250-2. doi: 10.1016/j.annemergmed.2024.11.019. Epub ahead of print. PMID: 39818676
